We report the case of a 10-year-old boy with a history of complex heart disease who underwent surgery, right multicystic multicystic, dysfunctional bladder and sacrociliac hypoplasia.
Six months after a fall in the right buttock region, the patient developed dementia, initially requiring analgesia, but two weeks later she developed rectal abscess.
Magnetic resonance imaging showed a low medullary cone, with agenesis of the coxis; the sacral anus excavatum was distally assembled and extended into the anterior meningeal sac and the meningeal sac.
There is contrast uptake around the medullary cone, rectum sigma up to the anus, perineum and neighboring areas, indicating an infectious process.
It was decided to start medical treatment with great clinical improvement, finding the child asymptomatic within a few days.
The patient was discharged and delayed surgery was chosen.
Fifteen days later the patient was readmitted due to fever and new inflammatory signs in the right glue region, so intravenous antibiotic therapy should be restarted.
During this admission, the patient develops bacterial meningitis that needs to modify and prolong antibiotic treatment.
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The patient evolved favorably and once the medical treatment was completed, it was decided to surgically approach the meningocele.
Under neurophysiological monitoring and a posterior approach, the defect region is located.
The dissection showed a tubular fibrous structure that communicated the intramedullary canal with the anterior dural sac.
This article opens up the neck of this rare malformation 5cc accumulated in the pelvic cavity.
The neck of the dural defect was then resected and the anterior meningocele of the medullary canal was completely isolated.
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The postoperative course was uneventful, continuing for a few weeks with antibiotics.
After radiological confirmation of the correct resolution of the meningocele, it was decided to discharge home with outpatient follow-up.
After one year, the patient is asymptomatic.
The perianal abscess fistulized spontaneously leaving only a small area of adiponecrosis in the right gluteal region.
The last MRI showed disappearance of the perirectal abscess and slight uptake only in soft tissues, with no images compatible with persistent meningocele.
